Xinying Sun

Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model

BackgroundHealth literacy has been defined as the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. Currently, few studies have validated the causal pathways of determinants of health literacy through the use of statistical modeling. The purpose of the present study was to develop and validate a health literacy model at an individual level that could best explain the determinants of health literacy and the associations between health literacy and health behaviors even health status.MethodsSkill-based health literacy test and a self-administrated questionnaire survey were conducted among 3222 Chinese adult residents. Path analysis was applied to validate the model.ResultsThe model explained 38.6% of variance for health literacy, 11.7% for health behavior and 2.3% for health status: (GFI = 0.9990; RMR = 0.0521; χ2 = 10.2151, P = 0.1159). Education has positive and direct effect on prior knowledge (β = 0.324) and health literacy (β = 0.346). Health literacy is also affected by prior knowledge (β = 0.245) and age (β = -0.361). Health literacy is a direct influencing factor of health behavior (β = 0.101). The most important factor of health status is age (β = 0.107). Health behavior and health status have a positive interaction effect.ConclusionThis model explains the determinants of health literacy and the associations between health literacy and health behaviors well. It could be applied to develop intervention strategies to increase individual health literacy, and then to promote health behavior and health status.

Determinants of risky sexual behavior and condom use among college students in China

The purposes of this study were to assess sexual behavior and condom use among Chinese college students, and to explore social-environmental and social-cognitive determinants associated with risky sexual behaviors within this population. A survey was conducted among 19,123 Chinese college students recruited through stratified cluster sampling. About 9% of the students reported having had sex (male=13.3%, female=5.0%, OR=2.918), 3.6% had multiple sexual partners (male=5.7%, female=1.6%, OR=3.624), and 0.9% had commercialized sex (male=1.6%, female=0.3%, OR=6.169). Only 24.8% of sexually active students had used a condom for every sexual encounter, and there was no significant difference in condom use between male students and female students. Logistic regression showed that sex (female, OR=0.769), age (older, OR=1.263), exposure to pornographic information (higher, OR=1.751), drinking (intoxication, OR=1.437), and smoking (OR=2.123–5.112) were all determinants of sexual behaviors. Path analysis showed that exposure to pornographic information, level of consumption, and sex education were important social-environmental factors of condom use. Condom use was more common among those who had greater HIV/AIDS knowledge, attitudes toward high-risk behavior, self-efficacy, and intent to use a condom. Intentions were the most important and direct factor influencing condom use. The study concluded that college students are vulnerable to sexually transmitted diseases – including HIV/AIDS infection – through sexual contact. Therefore, future HIV/AIDS prevention and safer sex interventions should focus on self-protection skills and target behavior change.

How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials.

OBJECTIVES To study the effects of peer support on glycemic control and examine effects of different providers and types of support, intervention duration and effect duration.

Salt-Restriction-Spoon Improved the Salt Intake among Residents in China

Objective To evaluate the effect of an improved salt-restriction spoon on the attitude of salt-restriction, the using rate of salt-restriction-spoon, the actual salt intake, and 24-hour urinary sodium excretion (24HUNa). Design A community intervention study. Setting Two villages in Beijing. Participants 403 local adult residents being responsible for home cooking. Intervention Participants were randomly assigned to the intervention group or the control group. Those in the intervention group were provided with an improved salt-restriction-spoon and health education, and were informed of their actual salt intake and 24HUNa. Not any intervention was given to those in the control group. Main Outcome Measures The scores on the variables of Health Belief Model, the using rate of salt-restriction-spoon, the actual salt intake, and 24HUNa. Analysis Covariance analyses, Chi-square tests, Student’s t tests, and repeated measures analyses of variance. Results After 6 months of intervention, the intervention group felt significantly less objective barriers, and got access to significantly more cues to action as compared to the control group. The using rate and the correctly using rate of salt-restriction-spoon were significantly higher in the intervention group. The daily salt intake decreased by 1.42 g in the intervention group and by 0.28 g in the control group, and repeated measures analysis of variance showed significant change over time (F = 7.044, P<0.001) and significant difference between groups by time (F = 2.589, P = 0.041). The 24HUNa decreased by 34.84 mmol in the intervention group and by 33.65 mmol in the control group, and repeated measures analysis of variance showed significant change over time (F = 14.648, P<0.001) without significant difference between groups by time (F = 0.222, P = 0.870). Conclusions The intervention effect was acceptable, therefore, the improved salt-restriction-spoon and corresponding health education could be considered as an alternative for salt reduction strategy in China and other countries where salt intake comes mainly from home cooking.

Measuring health literacy regarding infectious respiratory diseases: a new skills-based instrument.

Background There is no special instrument to measure skills-based health literacy where it concerns infectious respiratory diseases. This study aimed to explore and evaluate a new skills-based instrument on health literacy regarding respiratory infectious diseases. Methods This instrument was designed to measure not only an individual’s reading and numeracy ability, but also their oral communication ability and their ability to use the internet to seek information. Sixteen stimuli materials were selected to enable measurement of the skills, which were sourced from the WHO, China CDC, and Chinese Center of Health Education. The information involved the distribution of epidemics, immunization programs, early symptoms, means of disease prevention, individual’s preventative behavior, use of medications and thermometers, treatment plans and the location of hospitals. Multi-stage stratified cluster sampling was employed to collect participants. Psychometric properties were used to evaluate the reliability and validity of the instrument. Results The overall degree of difficulty and discrimination of the instrument were 0.693 and 0.482 respectively. The instrument demonstrated good internal consistency reliability with a Cronbach’s alpha of 0.864. As for validity, six factors were extracted from 30 items, which together explained 47.3% of the instrument’s variance. And based on confirmatory factor analysis, the items were grouped into five subscales representing prose, document, quantitative, oral and internet based information seeking skills (χ2 = 9.200, P>0.05, GFI = 0.998, TLI = 0.988, AGFI = 0.992, RMSEA = 0.028). Conclusion The new instrument has good reliability and validity, and it could be used to assess the health literacy regarding respiratory infectious disease status of different groups.

Relationships of Health Literacy, Health Behavior, and Health Status Regarding Infectious Respiratory Diseases: Application of a Skill-Based Measure

This study aimed to explain the relationships among health literacy, health behavior, and health status, using a newly developed skills-based measure of health literacy regarding respiratory infectious diseases. This instrument was designed to measure individuals’ reading, understanding, and calculating ability, as well as their oral communication and Internet-based information-seeking abilities. A pilot survey was conducted with 489 residents in Beijing, China, to test the reliability and validity of the new measure. Next, a larger study with 3,222 residents in three cities with multistage stratified cluster sampling was implemented to validate a latent variable model (goodness of fit index = 0.918, root mean square residual = 0.076). In this model higher educational attainment (β = 0.356) and more health knowledge (β = 0.306) were positively and directly associated with greater health literacy skill, while age was negatively associated with it (β = − 0.341). Age (β = 0.201) and health knowledge (β = 0.246) had positive and direct relationship with health behavior, which was, in turn, positively associated with health status (β = 0.209). The results illustrate the complex relationships among these constructs and should be considered when developing respiratory intervention strategies to promote health behavior and health status.

Occupational exposure to blood and compliance with standard precautions among health care workers in Beijing, China

This cross-sectional survey assessed both risk and prevention of health care workers to bloodborne virus transmission in 2 hospitals in Beijing. The identified discrepancy between the high level of occupational blood exposure and suboptimal compliance with standard precautions underscores the urgent need for interventions to enhance occupational safety of health care workers in China.

Determinants of salt-restriction-spoon using behavior in China: application of the health belief model.

Background The two-gram salt-restriction-spoons, which can be used to reduce the salt intake of people, had been handed out for free by the Chinese government to the citizens several years ago, but only a small fraction of residents use such a spoon currently. Since no studies have been conducted to investigate relevant influencing factors, this study was designed to explore the determinants of salt-restriction-spoon using behavior (SRB) in China. Methods This cross-sectional study was conducted in Beijing, China. Altogether 269 rural residents and 244 urban residents aged over 18 were selected by convenience sampling method in 2012. Variables measured in a questionnaire designed according to the Health Belief Model (HBM) included socio-demographics, perceived susceptibility, perceived severity, perceived benefits, perceived objective barriers, perceived subjective barriers, self-efficacy, knowledge of hypertension, cues to action, and SRB. Answers to the questionnaire were obtained from all the participants, and 24-hour urine samples were collected to determine the 24-hour urinary sodium excretion (24HUNa). Path analyses were used to explore the determinants of SRB. Results Approximately 22.7% and 45.3% of residents used a salt-restriction-spoon everyday in the rural and urban areas, respectively. The average 24HUNa was 211.19±98.39 mmol for rural residents and 109.22±58.18 mmol for urban residents. Path analyses shown that perceived objective barriers, perceived benefits, perceived severity, knowledge and age were related to SRB and 24HUNa for both rural and urban participants, among which perceived objective barrier (β =  − 0.442 and β =  − 0.543, respectively) was the most important determinant. Conclusion Improvement of the current salt-restriction-spoon and education on the right usage of the salt-restriction-spoon, the severity of hypertension, and the benefit of salt reduction are necessary, especially among those who are relatively young but at risk of hypertension, those who have lower education levels, and those who live in the rural areas.

Are condom-promotion interventions reaching internal migrants in China? Integrated evidence from two cross-sectional surveys.

ABSTRACT Behavioral interventions containing behavior change techniques (BCTs) that do not reach the target populations sufficiently will fail to accomplish their desired outcome. To guide sexually transmitted infection prevention policy for internal migrants in China, this study examines the extent to which BCTs aiming at increasing condom use reach the migrants and investigates the preference of the target population for these techniques among 364 migrants and 44 healthcare workers (HCWs) in Shenzhen, China. The results show that condom-promotion techniques that had been offered by HCWs to internal migrants reached a limited proportion of the population (range of reach ratio: 17.6–55.0%), although there appears to be a good match between what is offered and what is preferred by Chinese internal migrants regarding condom-promotion techniques (rank difference ≤ 1). Our findings highlight the need to increase the reach of condom-promotion techniques among Chinese internal migrants, and suggest techniques that are likely to reach the target population and match their preferred health education approaches.

A Quantitative Exploration of Health Care Workers Opinions and Attitudestowards HIV-Infected Co-Workers and Patients in Beijing, China

This study examines underlying stigmatizing opinions and attitudes of health care workers (HCWs) that may drive discrimination towards HIV-infected co-workers and patients in the workplace. Socio-demographics, opinions regarding managing HIV-infected co-workers, and attitudes regarding working with HIV-infected patients were measured using a self-administered anonymous questionnaire in a sample of 392 HCWs (113 doctors, 236 nurses and 43 technicians) in Beijing. Participants perceived a high risk of HIV transmission in both co-worker and HCW-patient relationships. Half of participants agreed that HCWs should routinely and mandatorily receive HIV-tests, HIV-infected co-workers should disclose their diagnosis to relevant parties, and should be restricted from performing invasive procedures. Most of participants feel disgusted by patients infected through sexual contact, and believed that HCWs have the right to refuse to care for infected patients, and that those patients should be treated only in designated hospitals. Almost all participants intended to avoid performing invasive clinical procedures or nursing services for HIV-infected patients. Nurses had significantly more stigmatizing attitudes towards HIV-infected patients than doctors and technicians. The identified rigid opinions on managing HIV-infected co-workers, together with stigmatizing attitudes towards HIV-infected persons, underscores an urgent need for interventions to prevent discriminatory practices in health care settings.